What is endometriosis?
Endometriosis is a condition in which the type of tissue that forms the lining of the uterus (the endometrium) is found outside the uterus.
How common is endometriosis?
Endometriosis occurs in about 1 in 10 women of reproductive age. It is most often diagnosed in women in their 30s and 40s.
Where does endometriosis occur?
Areas of endometrial tissue (often called implants) most often occur in the following places:
- Fallopian tubes
- Outer surfaces of the uterus, bladder, ureters, intestines, and rectum
- Cul-de-sac (the space behind the uterus)
How does endometriosis cause problems?
Endometriosis tissue responds to changes in a hormone called estrogen. The tissue may grow and bleed like the uterine lining does during the menstrual cycle. Surrounding tissue can become irritated, inflamed, and swollen. The breakdown and bleeding of this tissue each month also can cause scar tissue to form. This scar tissue is called adhesions. Sometimes adhesions can cause organs to stick together. The bleeding, inflammation, and scarring can cause pain, especially before and during menstruation.
What is the link between infertility and endometriosis?
Almost 4 in 10 women with infertility have endometriosis. Inflammation from endometriosis may damage the sperm or egg or interfere with their movement through the fallopian tubes and uterus. In severe cases of endometriosis, the fallopian tubes may be blocked by adhesions or scar tissue.
What are the symptoms of endometriosis?
The most common symptom of endometriosis is chronic (long-term) pelvic pain, especially just before and during the menstrual period. Pain also may occur during sexual intercourse. If endometriosis affects the bowel, there can be pain during bowel movements. If it affects the bladder, there can be pain during urination. Heavy menstrual bleeding is another symptom of endometriosis.
Many women with endometriosis have no symptoms. Women without symptoms often learn they have endometriosis when they cannot get pregnant or when they are having surgery for something else.
How is endometriosis diagnosed?
The doctor first may do a physical exam, including a pelvic exam. But the only way to tell for sure that you have endometriosis is through a surgical procedure called laparoscopy. Sometimes a small amount of tissue is removed during the procedure and tested in a lab. This is called a biopsy.
How is endometriosis treated?
Treatment for endometriosis depends on the extent of the disease, your symptoms, and whether you want to have children. Endometriosis may be treated with medication, surgery, or both. When pain is the primary problem, medication usually is tried first.
What medications are used to treat endometriosis?
Medications that are used to treat endometriosis include pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), and hormonal medications, including birth control pills, progestin-only medications, and gonadotropin-releasing hormone (GnRH) agonists. Hormonal medications help slow the growth of the endometrial tissue and may keep new adhesions from forming. These drugs typically do not get rid of endometriosis tissue that is already there.
How can surgery treat endometriosis?
Surgery helps remove endometriosis tissue. Removing this tissue may relieve pain and improve fertility.
Does surgery cure endometriosis?
After surgery, most women have relief from pain. But there is a chance the pain will come back. Up to 8 in 10 women have pain again within 2 years of surgery. This may be due to endometriosis that was not visible or could not be removed at the time of surgery. The more severe the disease, the more likely it is to return. Taking birth control pills or other medications after having surgery may help extend the pain-free period.
How is gonorrhea treated?
Gonorrhea is treated with two kinds of antibiotics. The recommended treatment is an injection of one antibiotic followed by a single pill of another antibiotic. If the injection is not available, you can take two types of antibiotic pills. This treatment also is effective against chlamydia. Your sex partners also need to be tested for gonorrhea and treated.
What if I still have severe pain that does not go away even after I have had treatment?
If pain is severe and does not go away after treatment, a hysterectomy may be a “last resort” option. Endometriosis is less likely to lead to future pain if your ovaries are removed at the time of hysterectomy. Either way, the goal of surgical treatment is to remove as much as possible of the endometriosis that is found outside the uterus.